A 39-year-old male with a prior history of recurrent stone formation, presents with right-sided flank pain, burning urination and vomiting. On physical examination, there is tenderness over the right lumbar area. The patient had a history of sudden weakness for which he received several shots of Vit-D injection over the last year. His father died because of renal failure.
Review of his lab tests showed the following:
Test |
Value |
S. Creatinine |
1.17 mg/dL |
S. Corrected Calcium |
10.5 mg/dL |
S. Phosphorus |
3.3 mg/dL |
25 (OH) Vit D |
98 ng/mL |
iPTH |
33 pg/mL |
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this is a case of hypervitaminosis D with mild hypercalcemia and normal phosphorus and PTH level, mostly due to large doses received in the last year.
may be complicated by stone formation causing the flank pain.
given the data of positive family history with the presence of stone- 24-hour urinary( calcium, oxalate, citrate)
Labs show hyper-vitaminosis D, Ca upper normal
Further investigations are needed: complete metabolic panel, urine analysis, urine c/s, pelviabdominal USG, CT KUB, if no stones were detected: 24hrs urinary profile.
Vid d intoxication with hypercalcim
Urinalysis +C/S
Metabolic screen
Stone analysis
Abdomen U/S, CT
1- hypercalcemia with high vitamin D level
2- kub , Us
hypercalcaemia due hypervitaminosis
hypercalcaemia causing stone
Urine dip/msu/ urine culture /non contrast CTKUB 24 hr urine volume,ph citrate,oxalate calcium uric acid ,cysteine due to FH
interpret the above laboratory investigations.
high vitamin level other lab investigation is with in normal range
the flank pain could be due to renal stones combined with vit D intoxication …
taking too much vitamin d can cause renal stones
further lab investigation .. cbc , renal function test, urinalysis ,,KUB ct
1- upper normal calcium level with vit D intoxication
other labs are within normal range
2-urine analysis , CBC, Abd US, spiral CT abd and pelvis , 24h urinary calcium excretion
Interpret the above laboratory investigations.Patient has high level of vit D and calcium due to recurrent stone formation
Would you recommend any further laboratory investigations.Abdomin/pelvis U/SUrine analysis and urine cultureKUB x rayCT KUB24 hour urinary (volume, calcium, oxalate,citrate, uric acid, and creatinine)RFTCBC
Thank you dear colleagues for your great contributions.
Here are the explanation for this part.
A. Interpret the above laboratory investigations.
The patient presented according to his laboratory investigations by high levels of vitamin D and hypercalcemia. Mostly these abnormalities are the cause of the patient’s complaint and recurrent renal stone formation.
B. Would you recommend any further laboratory investigations.
The patient presented with flank pain and burning urination. So, it is highly suspected for either nephrolithiasis or urinary tract infection.
Pelviabdominal ultrasound to comment especially on the urinary tract, urine analysis and urine culture are also important. Complete blood count is helpful. Spiral CT abdomen may be needed to confirm the presence of renal stones. Since the patient has recurrent history of renal stones and positive family history of renal disease, a metabolic panel is needed including 24 hour urinary (volume, calcium, oxalate,citrate, uric acid, and creatinine) and serum uric acid.
Normal kidney function, with hypercalcemia and hypervitaminosis (D). For urinary calcium. TSH. Serum K, mg. ALP. CT-KUB
Interpret the above laboratory investigations.
upper normal serum creatinine.
hypervitaminosis D.
mild hypercalcemia.
normal serum PTH.
Would you recommend any further laboratory investigations.
urinalysis
Urine C/S
Metabolic screen
Stone analysis
Abdomen U/S, CT
Abdomen KUB
1-Lab interpretation ca at upper level
Vit d level was high near to toxic level normal
2-other lab recommended exclude mm via spep serum mg work up of renal stone 24 hr ca ,mg, oxalate and po4 and uric acid
1.Interpret the above laboratory investigations.
Hypervitamosis D, with mild hypercalcemia
2.Would you recommend any further laboratory investigations.
U/S KUB, CT Kidney
urine analysis and culture
S.uric acid
24-hour urine for stone panel and (calcium /creatinine)
serum bicarbonate
THIS PATIENT HAS STAGE 2 CKD BASED ON EGDR , HIS PAIN MOSTLIKLY URETRIC COLIC WITH UTI OR LOWER URETRIC STONE NEEDS FOR URGENT ULTRASOUND OR NONCONTRAST CT SCAN , URINE ANALYSIS , URINE ELECTROLYTES ALSO
1. Upper normal s. Creatinine , high level of vitamin D level
2. S. Na, K., Mg , s. Uric acid
BGA
US of renal system or CT abdomen
24 hrs Urine Ca, phosphorous, uric acid, oxalate, citrate, cysteine, creatinine
The above lab result
Shows normal kidney function, with hypercalcemia and hypervitaminosis (D).
Further recommended investigation
Interpret the above laboratory investigations.
Likely he has symptomatic kidney stones vs pyelonephritis
Would you recommend any further laboratory investigations.
plain: for volume, pH,Na,K,citrate,urate,and Cysteine level
acid: for volume, Ca,Pi and oxalate level
1.there is excess of vitamin D and mild hypercalcemia
2Ultrasound of kidney and maybe CT to exclude nephrolithiasis
Urinary status should be analysed,and 24 Urin for Calcium , oxalate ,citrate, phosphate and uric acid.
Mild hypercalcemia with a high vitamin D level. Vitamin d overdose seems to be the cause. Nephrocalcinosis and urinary stones are frequent. We need urinary CT or US to confirm and decide about the need of emergent urologic intervention
mild hypercalcemia, mild hypophosphatemia, normal PTH, high Vit-D, stone former with the manifestation of acute renal colic most likely second to stone
U/S KUB, CT Kidney
urine analysis and culture
S.uric acid
24-hour urine for stone panel and (calcium /creatinine)
serum bicarbonate
Interpret the above laboratory investigations.
Would you recommend any further laboratory investigations.
This patient lab showed hypervitaminosis D with mild hypercalcemia
she had normal PTH and PO4 level
will need to have Us abdomen to see if she is passing a stone.
Interpret the above laboratory investigations.
Would you recommend any further laboratory investigations.
1-mild hypercalcemia with normal serum po4 and PTH ,high 25(OH )D3
2-ask for
24 hour collection of calcium ,uric acid ,oxalalte )
serum K and hco3 to r/o RTA
uric acid
kidney uss
Interpret the above laboratory investigations.
High vit D level- normal PTH and phosphate
patients complaint is consistent with renal stone due to Vit-D injection
2. Would you recommend any further laboratory investigations?
Urinalysis
Uric Acid Level
24-hr urinary calcium
Renal ultrasound or abdominal CT
Serum alkaline phosphatase
39y/o/m c/o rt. flank pain w dysuria , vomiting
hist. of renal calculi , hist. of shot inj. vit.D ,hist.of sudden weakness and family hist. of father died from renal failure
lab. revealed
hyper vit. D , hyper calcemia
normal scr. and pi . and iPTH
RECOMMENDATION
f/u renal function and abg -cbc urine analysis , 24 h protein in urine and urine c/s
imaging kidney sonar and ct
Interpret the above laboratory investigations.
Would you recommend any further laboratory investigations.